OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Patient #2 Survey Completes

IC 216612 under ICR 201505-0910-003 · OMB 0910-0801.

Documents and Forms
Document Name
Document Type
Other-Optum Patient Pill Appearance
Other-Optum Patient Survey Informed
Other-Optum Patient Survey Initial I
Other-Optum Patient Survey Second In
Information Collection (IC) Details

View Information Collection (IC)

Patient #2 Survey Completes CDER
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-Optum Patient Pill Appearance Survey Appendix 3. Optum Patient Pill Appearance Survey.docx Yes Yes Fillable Fileable Signable
Other-Optum Patient Survey Informed Consent Statement Appendix 10. Optum Patient Survey Informed Consent Statement.docx Yes Yes Fillable Fileable Signable
Other-Optum Patient Survey Initial Invitation Appendix 9. Optum Patient Survey Initial Invitation Letter.doc Yes Yes Fillable Fileable Signable
Other-Optum Patient Survey Second Invitation Appendix 11. Optum Patient Survey Second Invitation Letter.doc Yes Yes Fillable Fileable Signable

Health Consumer Health and Safety

 

1,000 0
   
Individuals or Households
 
   20 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,000 0 1,000 0 0 0
Annual IC Time Burden (Hours) 300 0 300 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
No associated records found
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.